Sahu Kamal Kant, Pandey Deepali, Mishra Ajay Kumar, O'Shea James, Chen Yayan, McGregor Bradley
Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Division of Hematology and Medical Oncology, Saint Vincent Hospital, Worcester, Massachusetts, USA.
BMJ Case Rep. 2019 Aug 26;12(8):e230215. doi: 10.1136/bcr-2019-230215.
We present the case of a 55-year-old male patient who presented with palpable cervical lymphadenopathy. Excisional biopsy showed metastatic adenocarcinoma of unknown origin. Imaging showed a bladder mass following which he underwent transurethral resection of bladder tumour. Histopathological evaluation of mass confirmed a poorly differentiated adenocarcinoma with signet-ring cell features. Immunohistochemistry was suggestive of metastatic urachal cancer. He agreed for enrollment in a clinical trial, however soon after 1st cycle, he developed immune pneumonitis requiring high dose steroids. On follow-up, MRI brain was done for evaluation of headache which showed metastatic intracranial disease. He completed radiotherapy following which he was started on FOLFOX chemo regimen (folinic acid, 5-fluorouracil and oxaliplatin).
我们报告一例55岁男性患者，其表现为可触及的颈部淋巴结肿大。切除活检显示为来源不明的转移性腺癌。影像学检查显示膀胱有肿物，随后他接受了经尿道膀胱肿瘤切除术。肿物的组织病理学评估证实为具有印戒细胞特征的低分化腺癌。免疫组化提示为转移性脐尿管癌。他同意参加一项临床试验，然而在第1周期后不久，他出现了免疫性肺炎，需要使用大剂量类固醇。在随访过程中，为评估头痛进行了脑部MRI检查，结果显示有颅内转移病灶。他完成放疗后开始接受FOLFOX化疗方案（亚叶酸、5-氟尿嘧啶和奥沙利铂）治疗。
